Twenty Hours Ago

The route from the hospital to town, passing between two villages.
For most of the year it is dry and sandy.

Twenty hours ago, my friend Sue and I left the hospital at Guinebor to go into town to run a few errands and go to a friend’s house for the afternoon. The trip to town, for much of the year, is an uneventful 20 minute journey, initially made up of 7 kilometres of sandy tracks passing through a couple of small villages before reaching the faster and more predictable (in surface, though not necessarily the fellow road users style of driving!), roads. However, at the recent arrival of the rains and their increasing frequency and strength, the surrounding landscape has become more lush and green, while the once sandy tracks have taken on an increasingly muddy, watery, clayey and all round unpredictable character. This makes for a far more interesting, potentially exciting, but also uncertain journey- will the route be clear? Will I come out the other side of this puddle, or will I fall into a submerged pothole? Will I get stuck in thick stinking mud? And if I do, will anyone come to help me, or, as they did in the first wet season here, will they just line up to watch the white girl sit helplessly in her car and laugh?! (One of my more humbling moments!)

Having a second person in the car with me and a rope at the ready in the boot, I felt confident as we set out yesterday. The roads, as expected had deteriorated since I had last left the hospital following a day of continuous rain. But with 2 pairs of eyes on the lookout for the best way forward, I was able to enjoy the experience of slipping and sliding my way to successfully pop out the other side of the villages onto the paved roads, all the while, smugly reflecting on the fact that in the UK, people pay good money for a days’ off road driving experience!

Things were going well, the sky was blue, not a cloud to be seen, the sun, as usual, was shining and the required errands were being ticked off the list. But then the winds began to pick up. The clouds began to gather and darken. And the distant rumbling of thunder became ever closer. As we sat in my friends lounge, the worried glances of mine and Sue’s faces were quickly noted by others, but as the rain began to stream down, there was nothing we could do but wait until the worst had passed.

Though heavy, the rain had not lasted long so we headed home once it had stopped, once again feeling confident that we would be able to negotiate our way through the quagmire that the roads had no doubt become. That was until we received a phone call from Sue’s husband, who, back at Guinebor, was ladling rain water out from their house, where the storm was so heavy, rain was seeping through the walls, as well as pouring through the windows. The space between our two houses had disappeared into a knee deep lake, totally surrounding my house. Beyond the hospital walls, the land had taken on a distinctly more oceanic character.  Getting back home for us, was now not an option.

An urgent phone call to a friend based in town saw us well looked after for the night, where unfortunately, the circumstances surrounding our impromptu stay, diminished the delight of satellite TV, air conditioning and an extremely comfortable bed… but only slightly. If you have to be stuck in town for the night, there were definitely worse places to be….!

As is often the case here, our unplanned stay in town was not the only challenge, but was also accompanied by the house we were staying in to randomly loose all power and then in the morning, following a phone call to confirm that after no further rains the roads were passable again, my car wouldn't start!

However, Dago, the hospital driver, and once again, my knight in long Arabic dress, within a mud covered rattley Rav 4, came to the rescue! With my car up and running once again, we set off in convoy to conquer the watery challenge of Guinebor! It was incredible to see just how much it had dried out overnight, for though it was worse than our exit journey yesterday and there were dodgy moments of following a skidding and half submerged Dago, the route was not vastly worse than the day before.

The rains dramatically change the landscape, causing houses
 to flood and routes to become impassable.

After a night of no rain the route had significantly improved
allowing us to drive home

All that was left to do once safely and dryly back home, was to feed a rather unhappy and hungry cat, assure myself that no permanent damage had been caused to the house and unpack the groceries that I felt like I had brought the week previously, and not, as was actually the case, only twenty hours ago.

The lake of Guinebor! Home, sweet watery home.

Going East

Last week I found myself at 4am, just before sunrise, being awoken by my alarm. I momentarily enjoyed the uncharacteristically cool breeze that was blowing on me in my outdoor bed, before throwing the last few essentials into a bag (pineapple, baby wipes and canned pears), then leaving in search of the bus station across town. Not being a person who particularly relishes such early starts or who lives in the city, this trip afforded a rare insight for me into the waking world of N‘Djamena.

Following a busy and very hot couple of months at the hospital I was taking a break and was off to visit some friends in the east of Chad. A battered old bus, with intermittent air conditioning and a television showing the same 10 minutes of reel, thankfully without sound, was my chariot for the next 6 hours. Grateful for a seat rather than the popular mode of transport atop an overloaded truck, I settled down. Leaving the dirt and bustle of the city behind, the wide wide expanse of sand and sparse trees that traverses the whole of this vast country took over. An hour into the journey I was aware of a slight shift in my centre of gravity and realised that the road was indeed curving just ever so slightly!  Five hours more and a roundabout later, striking rugged rocks rose forming an impressive break to the otherwise changeless landscape. Six hours on, of uninterrupted travelling, we chugged to a stop in the next major bus depot. Though I would like to say I elegantly hopped and skipped over rolled up mats, plastic bowls and bursting bags that littered the central aisle of the bus, I actually found myself clumsily clambering and stumbling, heaving my heavy bag with me, taking out a few ankles along the way. All negotiated with long skirt and large headscarf in situ!

On descent I was immediately surrounded by children begging or trying to sell their wares of biscuits and dates to me, chatting away in Arabic. The large dusty, chaotic space that formed the bus station, was surrounded by various eateries bbqing indistinguishable meats over open fires or ladies selling juicy mangos. 

Through the chaos I spotted my next ride- a land cruiser manned by two white faces, a distinctive sight in this scene. While my friends finished off their business in their nearest ‘large’ town, including a new game we called ATM Roulette- will it be working this time? Will it work long enough to complete a transaction and maybe even 2?!, I enjoyed the opportunity to stretch my legs and take in the stark peace that filled the town away from the bus station and the sight of hills and trees.

An hour later, we were back on the road, this time, no tarmac (sorry, asphalt. Nod to Mr Dawson!). The journey was fast despite the surface and the increasingly green countryside whizzed past with occasional halts and swerves to avoid the odd wandering pedestrian, goat, herd of cows, water laden donkeys and most dangerously, the camels who literally have no common sense or comprehension that a vehicle is coming towards them and react in unpredictable and sometimes astonishing ways!

Village after village, made up of mud conical huts with thatched roofs passed and four hours later, as pot holes and deep crevices became more frequent in the road, we entered my holiday destination for the next 5 days.

The wide central road running the length of the small town, provides an open space for football matches to be played alongside, braying donkeys, pecking chickens, women wandering to and from the market and the passing of an occasional vehicle in a disorganised but calm fashion. At the end of the road, I am welcomed by my smiling friend and her young son as the sun began to disappear behind the horizon.

Self-dehydration was the method I had employed during the day to tackle the ‘unpredictable and severe shortage of facilities’ during the journey. And so, amongst the excited chatter of reunited friends, I guzzled down a few litres of water and experienced their ‘al fresco’ WC, reflecting on the great opportunity an open air toilet and shower offer in star gazing at night, and yet, the potential severe sun burn during the day!

The following day then set the pattern for the rest of the week; early morning and early evening were the times for making visits or receiving neighbours. The week proved a great opportunity for me to experience some of Chadian hospitality.

The first morning my friend took me with her to visit a sick neighbour who took a break from sifting her grain to receive us on her mat under a tree where we watched the children play together and they caught up on local news and the state of her and her families health, while I desperately listened out for the odd word of Arabic I could understand.

Through the week, having heard of my arrival, neighbours and co-workers of my friends called round to greet me. This entailed sitting on mats together, wearing head scarfs and drinking small glasses of incredibly sweet hot tea. During one such visit, while my friend prepared the obligatory refreshments, I found myself sat next to a lady, who as far as I could tell was extremely lovely but I had no way of actually talking to her! 

Having only partially successfully mumbled my way through just some of the long Arabic greeting, I found myself desperately looking around trying to find something to point to or talk about to break the painful silence. I was transported back to my first few months in Chad where I experienced this on a daily basis as I grappled with French. To realise I can now make conversation in albeit, not the most eloquent of French, was a happy moment.

Being in a rural setting I adopted the local dress of wearing a lafai, a long piece of cloth wrapped around me, covering my head to ensure modesty. Despite the challenge of wearing an extra layer in the heat and the practical side of trying to walk, move, do anything useful in swathes of material, I actually enjoyed my alternative holiday wear.

The rest of the week was taken up with eating, chatting, sleeping, playing games and generally relaxing. One afternoon, as it began to cool down, we all piled into the vehicle and went off to explore the dried up wadi on the outskirts of town to search out a place for a picnic. Some serious off road driving up and down the banks and through the bush found just such a secluded spot and we passed a very pleasant hour or so walking, admiring the trees, playing a game, munching on cookies. While walking along the wadi my eye was caught by large round pools formed in the centre of the dried river bed with packed mud rims. Each shallow pool had a piece of plastic draped over the rim next to a small but deep hole. It transpires that this is the camel watering system used here- the small holes go down 2 metres deep to reach water which is drawn up and poured into the large shallow pools, the plastic protecting the fragile mud rims from being washed away by the water. Yet another example of me learning so much more of this vast country.

The final morning was spent wandering around the low stalls of the market examining local produce, negotiating prices and generally enjoying the buzz found in many markets across of the world.

The end of the break came too quickly but as the return journey started the sights and enjoyment did not cease. Leaving the town behind, we regularly passed water laden donkeys ridden by young children and passed a huge camel train as a group of Nomadic people were on the move in search of their next camp. The camels were piled high with tents, various cloths and canvases as well as cooking utensils and tools, led by robed men and guided by children and women with their distinctive thickly braided hair.

As was the case on the previous bus journey, seats were much in demand and I was not able to get my preference of a seat near the front to see the way ahead, but was squished at the back. However, we were not on the paved road too long before I was grateful that I couldn’t see what was coming ahead. I eased into the swerves and frequent emergency stops that were pulled, as slower vehicles were over taken and local wildlife, mostly goats and cattle were negotiated, taking a deep breath and adopting the local saying “Inshallah”, “God’s will”.

The hotter, busier city awaited to welcome me back, but as I have returned to work, I have been struck as I have met and interacted with some of the patients here that I have a little more understanding of where they have travelled from, the challenges of distance and cost that brings, as well as the responsibilities they have left behind in their villages to come and seek health care. I also returned feeling excited, refreshed and eager for my next sugar packed glass of tea.

The Joys of Hot Season

N’Djamena has been reported as being one of the hottest cities in the world. The height of hot season has just been upon us here and the temperatures continue to daily reach the mid to high 40’s, and even occasionally cross the 50c line, it is not my favourite time of the year here. While I await spontaneous combustion to finally take me, or to melt into a pool of sweat, it is very easy to let the misery take over. A few weeks into this, however, enough is enough. I have decided that now is the time to think positive. And so, here we are, the positives sides of hot season (may need to get creative!)…..

1.    Top reason- hot season brings with it mango season. The huge, sweet juicy fruits offer a source of much delight and creative spirit as the team here come up with 101 different thing to do with a mango: Mango crumble, mango ice cream, mango just as mango, mango chutney… Any more ideas or suggestions are welcome...

Mangoes, even bigger than cats!

2. Hot season provides the ultimate extreme de- tox experience for the whole body as you drink litres and litres and litres, to then loose it all again through your pores. Plus, the frequent hot sandstorms that blow through can provide an incredibly intense, and occasionally painful, exfoliation!

3. Opening the fridge is always a surprise, finding a computer battery and perhaps a collection of candles, amongst bottles of luke warm water and wilting vegetables

4 . Speaking of candles, take them out of the fridge and you can make your own piece of modern art

5. And speaking of the fridge, err, trying to think of something positive to say about it in hot season… Oh yes, new experiences. I now find myself on a daily basis doing something I had never before considered necessary to do- watering my fridge!

6.  And should, on your way to the fridge with a bowl of water, you accidently tip the bowl over flooding the kitchen (or happily, soaking yourself), fear not. Don’t waste precious energy by clearing it up, give it 5 minutes and the floor (or yourself, excluding the sweat) will once more be as dry as bone. Being dry and crispy is true, not only of clothes and water spillages, but also for fruit and vegetables; they do not rot, they dry. So too for a poor deceased frog I found while clearing out a store room!

Crispy

7. You also see things you never considered possible, like melting solar panels. Surely solar panels should be ok in the heat, being designed to be put in the sun and all? But not the Chadian sun. I’ve been through 2 solar panels so far this year and the solar run traffic lights in town were out of order for some weeks while the melted panels were replaced (not that it had any impact on the driving conditions!)

8. Costs of running a gas cooker are reduced- for cooking and baking, chocolate and butter come ready melted and water boiled 12 hours previously remains hot enough to brew a cup of tea with. (Yes, it may be 40 plus degrees, but there is always a place for a cup of tea!)

9. Sleeping under the stars is a daily routine to escape the heat that the house walls have absorbed during the day and continue to radiate back into the house during the night. (Either that, or, as I did when I was doing language learning in town and couldn’t sleep outside due to rats the size of small dogs, preparing to go to bed involved many steps to achieve a level of coolness compatible with sleep- spray bed, shower, put on pyjamas, clean teeth, spray bed again, shower with pjs on, soak towel in water, spray bed again, lay on wet bed in wet pjs, cover in wet towel, direct fan straight on to you- fine for around 30 minutes until towel dry and then try to ignore the increasing sweating until it becomes unbearable and start the process again!)

My Outdoor Bedroom- Minimalistic, but Ventilated

10. I now have a new found respect and appreciation for that everyday commodity that is salt. Ignoring all those messages about reduce salt intake I heard, and even gave before leaving the UK, here I add it to everything I eat and at least once a day, half a teaspoon to my juice in a desperate attempt to replace some the salt lost through excessive sweating.

So there we are, a whole 10 positives of hot season! But to finish off, here is a bonus positive of hot season:

When it all gets too much, the heat is overwhelming, everything you touch is hot, all energy is sapped and the numbers on the thermometer read 50.1c there is always the hope that maybe, just maybe, this will be the hottest I will ever have to be again, and from this moment on, it will always be just that tiny bit cooler!

Its not clear, but here is proof that it does actually get above 50c outside while it is a balmy 39.6c in my lounge. 

An Exciting Step Forward

It may come as no surprise to you who read this blog regularly when I say that I have a bit of a soft spot for the children I meet here in Chad. Yes, many of them are terrified of the strange colour of my skin and I can’t get anywhere near them without them screaming while the babies rarely wear nappies so having a cuddle with them can be a risky business! For older children, especially in the villages, their childhood is short lived as they become involved in the household tasks and looking after younger siblings. School is attended by some, but this can be intermittent and illiteracy is a real challenge here. In the evenings, when daily tasks have been completed and the heat of the day cools, toys are made from odd bits of sticks or rubbish found around the place. One popular game I’ve seen for little girls is to tie an old broken flip flop to their back as they carry on with their important tasks with their ‘baby’ securely attached.

Life for children here can be tough and in my line of work, obviously it is the health of the children that has particularly struck me since my arrival to Chad. Children who are undernourished, sick with easily preventable illnesses and diseases or children who are bought to the hospital too late have been challenging and difficult situations to see. Just over a year ago, the Hunger Prevention Programme was launched at Guinebor II in a bid to try and reduce the number of children suffering from easily preventable illness and to improve their health. During the first year of this project a new clinic was established available to all children to be weighed and receive free nutritious food, as well as the mothers being taught basic health promoting practices individually and in group settings.

However, a significant part of the project has only just been realised as the necessary equipment was located, bought, transported from Europe to Chad and finally installed in the hospital. It is with great excitement that the hospital here can now offer a fundamental service in child health- vaccinations.

The logistics of offering such a service have not necessarily been straight forward. For example, maintaining a strictly controlled cold chain for the storage of the vaccines is an important consideration. Unlike the UK, during some months of the year the temperatures in Chad are daily in the high 40’s and can occasionally break the 50C threshold. With no electrical power available, maintaining a cold chain of 2-8C is easier said than done. However, after much research a World Health Organisation approved solar powered vaccine fridge was sourced, funded by the Hunger Prevention programme and, having travelled from South Harrow, arrived a few weeks ago amidst great excitement. (With its ridiculously thick insulated wall to keep the cool in and the heat out, there was a significant sigh of relief when, after all the exterior packaging was stripped, it could indeed be squeezed through the door of the pharmacy with millimetres to spare!)

In the UK I had a basic understanding that vaccines were important, but it was only once I came here and witnessed the horror and distress of tetanus, the devastating effects of polio and the needless deaths of measles that I now have a fuller appreciation of something that in the UK I always took for granted.

Before vaccinations were available at Guinebor hospital, families had to walk to other health centres 15km away. Ignorance and misunderstanding of vaccines also contribute to the low vaccination rate of children in the local villages. Having a vaccination programme is promising for the local community, and I hope will reduce to one aspect of the many challenges children face growing up here.

 The run up to the launch of the programme, with the the arrival of the fridge, the training sessions from the World Health Organisation and the many practical considerations such a service requires were exciting, but it was nothing compared to the joy I felt of seeing the first child being vaccinated!

Miniature Miracles

 Working in a hospital with limited resources brings with it many challenges. But is also brings with it a real sense of amazement when, despite the lack of technology and the few basic drugs available, lives that look to be in serious danger miraculously are turned around. Over the past 4 days I have seen 2 such events.

Last Friday saw a tiny baby girl born 2 months premature 2 weeks ago in her village. She is her parents first and they are clearly besotted by her. Being so tiny though, feeding her was difficult and despite her parents’ best efforts she came to us very dehydrated and having difficulty breathing. She weighed just 1.200kgs. Her outlook did not look good and what little hope there was quickly faded when she stopped breathing. Quickly starting resuscitation, initially by basic mouth to mouth and then with a bag and mask, she started to breathe again and her slow heart rate picked up.

From that moment on, my day, and then much of the weekend, passed in a blur of giving fluids, antibiotics, monitoring her heart rate, oxygen levels and wrapping her up in yet more blankets, hats, jumpers and booties to ward off the chilly 25c nights! Unlike the many complex respiratory support systems found in UK hospitals, here we have simple oxygen concentrator which we used to help this little baby. The smallest mask we had completely covered her face!

By Sunday afternoon the little listless rag-doll that had been bought in 2 days previously was wriggling around, no longer needing oxygen and was able to take a few drops of milk by a syringe. Incredible! By Monday she was drinking all of her required milk so we could stop giving her fluids every 2 hours by the drip in her hand. Yesterday, as I sat with her parents helping them with feeding their precious little girl they told me they had given her the name Rebecca. What a privilege!

Me with Mum and Baby Rebecca

The second miniature miracle happened Sunday evening. A lady who had previously already lost 2 babies at birth came into the hospital in labour needing an emergency caesarean. As quickly as we tried to start the operation we thought we may already be too late. Her baby was born not breathing with a very weak pulse. I was meant to be giving the anaesthetic at the time so having given all the required medicine I ran over and helped a visiting American Doctor to resuscitate the baby while Dr Andrea continued to operate on the lady and Dr Mark was called to assist Andrea.  

The baby seemed to be making no attempt to breathe but we just kept on going. Finally her heart rate picked up and then there was some definite, if very feeble, breathes. In retrospect we realised that the whole resuscitation was only 20 minutes long, but at the time it felt an eternity as we watched this baby willing for her to start breathing on her own, knowing that if she didn't there was nothing more we could do to help her.

A proud new Mum with her miracle baby

Every so often Andrea would call me over to give some more anaesthetic drug to the lady and then I’d run back over to the baby again to be the second pair of hands resuscitating her.

And then we heard the most amazing noise ever; a surprisingly strong cry!!!!! Our whoops of joy and delight joined the baby’s cries to make the operating room a spontaneous party of celebration!

Although these two little babies are miniature miracles, the miracles were not miniature!

Moustapha

After a 3 month absence, I am now back in Chad. From August to the end of October this year I was in the UK travelling around various towns and cities, meeting and speaking with many of you who have been faithfully supported the hospital and the work that we are doing here in Chad, as well as me personally. Spending time with family and friends was also a significant part of my time at home, as well as eating lots of good English food!

During many of my visits in the UK I told a story about a little boy I met here this year called Moustapha. Moustapha was 18 months old when I met him on the paediatric ward back in June. He was severely underweight, weighing in at 5.4kgs. His arms were skinny, tummy bloated, skin covered in sores, his hair was sparse and dry, he had sickness and diarrhoea and was generally a very unhappy little boy. Moustapha was admitted for treatment for acute severe malnutrition.

Moustapha on day of his admission to hospital, weighing 5.4kgs

He was given enriched milk, along with various antibiotics, vitamins and minerals to help his weak body regain its strength and its ability to fight infection so that Moustapha could begin to put on weight.

The majority of children that are admitted with malnutrition are very sick and the first few days are can be critical. Getting the essential medicines and nutrition into them is very important, but can also be very difficult. With a painful tummy, drinking milk was not what Moustapha wanted to do, but with perseverance and a battle of wills over the first few days, it was not long before a noticeable difference began to occur. Within a week, Moustapha’s sickness and diarrhoea had stopped and his skin began to look better. He was also crying less, although still looked very lethargic and poorly.

During this time, Mariam, a lady who works in the children’s clinic in the hospital, spent time each day supporting Moustapha’s mother and explaining what food is good to feed Moustapha and the importance of basic hygiene in preventing infections. Mariam also held weekly cooking lessons for Moustapha’s and other mothers, during which she could practically demonstrate nutritionally rich recipes with locally sourced, affordable and seasonal food.

Mariam weighing a child in the Children's clinic

Three weeks later, Moustapha was a different boy; he weighed 6.2kgs and was consistently putting on weight on a daily basis. He looked happy, eagerly tucked into any food put in front of him and had those much desired chubby cheeks! Moustapha went home with little bags of enriched porridge flour and peanut butter paste which Mariam makes here at the hospital and we give away free of charge for all children who are underweight.

Moustapha on the day he left hospital weighing 6.2kgs

Moustapha has continued to put on weight since his discharge home, which we have monitored in the children’s’ clinic.

All children of 5 years and under who come to the hospital for medical help are screened for malnutrition, around a third of whom have been found to be moderately or severely malnourished. These children are hospitalised if needed or followed up by Mariam in the children’s clinic where their carer’s get lots of help and advice, as well as free nutritionally rich food.

Chad has the highest rate of malnutrition in the Sahel and West Africa region [1], the causes of malnutrition are extremely complex. UNICEF has estimated that 127,000 children in Chad were at risk of Severe Acute Malnutrition in the year 2012, a few of whom we have seen here at the hospital. Moustapha was just one of these children who we have had the joy and privilege of seeing healed. It costs about £48 to care for a child as an inpatient with acute severe malnutrition for 3 weeks. BMS World Mission, the organisation with whom I work, have produced Christmas gift tags, some of the proceeds of which will go towards the costs of caring for children such as Moustapha here at Guinebor hospital.

As I left the UK 3 weeks ago, the signs of Christmas were already around as people began the annual Christmas shop. If you would like to support the work with malnourished children here in Chad, then you can buy these Christmas tags from this link: bms christmas tags

[1] http://www.irinnews.org/report/97327/chad-s-health-system-struggles-to-combat-malnutrition

(permission was given by the mother of Moustapha to share his story and pictures)

See you soon

For the first time in ages, my feet are cold and I have a vague blue tinge to my fingers. Yes, you’ve guessed it, I’ve left the heat of Chad behind and have returned to the UK for 3 months for my first Home Assignment. As part of my work with BMS World Mission, at regular intervals I return to the UK to share with supporters some more about the work BMS is doing in Chad.  

My upcoming speaking dates are listed below, and should you be interested in hearing more stories, please come along.

18 August                      South Parade BC (am service, Connect congregation, pm                                       service, SENT congregation)

25 August (am)              Mill Rd BC, Wellingborough

1 September  (am)         Carey BC, Hemel Hempstead

15 September (am)        Abbey Centre BC, Northampton

22 Sept (am + pm)          Didcot BC, Didcot

28 (pm)-29 Sept (am)     Belmont Rd BC, Hemel Hempstead

6 October (am)                Latchford BC, Warrington

9 October (pm)                Queensberry BC, Nottingham

13 October (am + pm)     Moriah Baptist Church, Risca

 20 October (am)              Guiseley BC, Leeds

I am looking forward to seeing many of you in the upcoming weeks.